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For Patient Safety and Healthcare Improvement Poster Certificate I certify that Saleh Alghamdi presented a poster at the International Forum on Quality and Safety in Healthcare 2017 held at ExCel, London Thursday 27th April 2017 □ Friday 28th April 2017 □ Dr Ashley McKimm Head of Innovation and Improvement on behalf of BMJ and Institute for Healthcare Improvement 26-28 April 2017 ExCel London Conference Proceedings Igniting Collective Excellence We have always believed that everyone should get involved in improving healthcare, and our mission at the International Forum on Quality and Safety in Healthcare has always been just to do that - make healthcare improvement simple, support effective innovation and provide practical ideas that can be implemented in the workplace. This Conference Proceedings contains work submitted to us via our Call for Posters for this year’s International Forum taking place in London, UK, on 26-28 April 2017. The work volunteered by abstract authors for inclusion in this booklet is a reflection and a celebration of what the global quality improvement community has achieved over the past few years. You can find many projects from teams in countries such as UK, Singapore, Sweden, Australia, Nigeria, Brazil and more. Thank you to all those who have shared their work and have made it available in this digital format. We hope you enjoy this selection of abstracts and will join the International Forum improvement community to share your experiences, challenges, improvement successes and failures at our future events. Find out more about future International Forums at internationalforum.bmj.com. Abstract Reviewers We would like to thank our colleagues for their time spent reviewing poster and improvement science and research abstract submissions. Helen Bevan | Christopher Burton | Sonya Crowe | Pedro Delgado | Tim Draycott | Dougal Hargreaves | Joanne Healy Emelie Heintz | Andreas Hellstrom | Göran Henriks | Elin Larsson | Ian Leistikow | Beth Lilja | Cristin Lind | Carl Macrae Shaun Maher | Ashley McKimm | Ramini Moonesinghe | Fiona Moss | Margaret Murphy | Eleanor Murray | Jo-Inge Myhre Joseph Freer | Josephine Ocloo | Jennifer Perry | Kiku Pukk Härenstam | Martin Rejler | Anna Sarkadi | Johan Thor | Justin Waring Craig White | Sharon Williams | Thomas Woodcock | Ulrica von Thiele Schwarz Posterboard Number S42 Reducing prescribing errors through better feedback. A collaborative study across North West London hospitals Inderjit Sanghera North West London Hospitals NHS Trust, UK Helen Bell Imperial College Healthcare NHS Trust, UK Bryony Dean Franklin Imperial College Healthcare NHS Trust, UK Background In 2013 we developed the Prescribing Improvement Model (PIM), which aimed to improve patient safety by improving identification of prescribers and reducing prescribing errors in the hospital setting. The ‘change theory’ was that provision of feedback on prescribing errors would facilitate learning, reflection and changes to practice, and thus increase the safety of prescribing. Following successful local introduction and evaluation, we wanted to roll out the PIM interventions across North West London and to explore the extent to which the model could be used in other organisations.UK studies show that prescribing errors occur in 1-15% of inpatient medication orders. A common theme of the causes of prescribing error is that doctors get little feedback on errors they make, and are often unaware of having made them. One of the reasons for limited feedback in hospitals using paper-based prescribing is that prescribers can often not be identified from handwritten signatures. Method PIM was based on a three-part intervention: 1. To increase proportion of inpatient medication orders for which the prescriber has specified their name, in order to facilitate identification of prescribers; 2. To provide training to pharmacists to improve quality, consistency and frequency of feedback; 3. To facilitate shared learning from common and/or serious errors among pharmacists and doctors across North West London. 13 hospitals from 7 trusts took part. Prescribers were provided with name stamps and briefed about PIM. Pharmacists were provided with training on feedback techniques. A ‘good prescribing tip of the fortnight’ was sent to prescribers and pharmacists via email. The process measure was the proportion of inpatient medication orders for which the prescriber was identifiable. Outcome measures were prevalence of erroneous medication orders (established via pharmacists’ data collection) and prescribers’ and pharmacists’ attitudes to feedback (quantitative questionnaire). Outcome Findings suggest wide variation among hospitals in prescriber identification with some hospitals demonstrating significant improvements; there was no change overall. We identified a significant improvement in attitudes around feedback (p<0.001; unpaired t-test) and a small but statistically significant reduction in prescribing errors (pre-intervention 11%, post-intervention 9%; p=0.003; chi-squared test), with wide variation among hospitals. In one hospital, prescriber identification worsened post-intervention, due to a number of local factors. Removing this hospital from the calculation of overall effect on prescriber identification, the overall percentage of identifiable medication orders increased from 21% to 26% (p<0.001; chi-squared test). It was noted that two hospitals that had statistically significant improvements; in both cases the drug chart was redesigned as part of the intervention. Conclusion Following the introduction of a three-part intervention to improve feedback to prescribers on prescribing errors across thirteen hospitals, we identified an overall improvement in attitudes around feedback and a small but statistically significant reduction in prescribing error rates. We recommend that feedback should be part of a multifactorial approach to reduce prescribing errors. We believe working relationships between pharmacists and prescribers have also strengthened and we have raised awareness of the importance of providing meaningful feedback. Posterboard Number S133 Using Electronic Discharge Information to improve patient safety in anticoagulant prescribing Huw Rowswell Plymouth Hospitals NHS Trust, England Tim Nokes Plymouth Hospitals NHS Trust, England Background This project was in a large teaching hospital with some 50,000 annual admissions looking at the prescribing of the direct oral anticoagulants (DOAC) for treatment of venous thromboembolism. There was concern around safe prescribing of these drugs around loading and maintenance dose, duration of therapy and appropriate follow up after 3-6 months treatment as dictated by NICE. Method Radiological reporting was used to identify all thrombotic events then positive events were cross checked with the patient management system to see if they met the criteria to be termed hospital acquired thrombosis. This being any blood clot either diagnosed during an inpatient stay but not present on admission or within 90 days of hospital discharge. The prescribing information for all thrombotic events was then reviewed, using the electronic discharge system, to ensure the dosing was correct and appropriate follow up had been organised. The project started at the beginning of 2016 and within the first nine months 70 patients were identified who either had errors in their anti-coagulation prescribing or not been followed up as national guidance stated. As there are three main areas within the hospital where most DVT and PE diagnoses are made being the DVT clinic, ambulatory care and the acute GP service, these were the areas targeted when the project started. Outcome We have picked up these errors as detailed above and prevented many prescribing errors and possible patient harm. With the advent of duty of candor this is increasingly important. We have also ensured that NICE guidance around patient follow up is now being complied with and ensuring appropriate long term decisions are made. Conclusion Using electronic discharge and review of all new anti-coagulation prescribing for thrombosis has reduced errors, improved patient care and safety and ensured follow up of this patients has been carried out in an appropriate manner. Posterboard Number S170 Hardwiring Safety at Toronto Rehab, University Health Network Talya Wolff Toronto Rehab, University Health Network, Toronto, Ontario, Canada Susan Jewell Toronto Rehab, University Health Network, Toronto, Ontario, Canada Background Toronto Rehab (TR), University Health Network (UHN) is a five site rehabilitation, complex continuing care hospital and long-term care hospital, with 557 inpatient beds, in Toronto, Ontario, Canada. TR assists adults overcoming challenges of disabling injury, illness or age related health conditions to live active, healthier and more independent lives. Method Embracing safety as a core value, anticipating failure, having reliable processes and respect are key aspects of a culture of safety. In health care settings where these components exist, team members feel empowered to voice concerns. UHN is on a journey to become a high reliability organization. In 2015, TR implemented daily safety huddles to improve patient and staff safety. Huddles assist in creating a safety culture by giving staff and physicians a forum to share real-time safety concerns, raise opportunities for improvement and to identify good catches. This enables TR staff and physicians to live safety as a core value. The huddle process involves morning huddles on each unit led by managers, followed
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